2021 Annual Report

Report Summary

In 2021, the CHAG network like many health systems was still dealing with the COVID-19 pandemic which was in its second year of ravaging health systems across the world. Several lessons had been learned in the previous year. Among them was the indispensable need for partnerships. Accordingly, CHAG worked with several partners in continuing interventions that were initiated in the previous year to mitigate the impact of the COVID-19 pandemic on health service delivery and to ensure continuous provision of basic and essential health

Consequently, through the support of several partners, CHAG facilities were given considerable support that allowed them to respond to the COVID-19 pandemic in their respective communities. In particular, UKaid through the Foreign Commonwealth and Development Office (FCDO) funded the COVID-19 and Institutional Capacity Building (CRIB) project which started in 2020 in 40 districts where government had no district hospitals. The project successfully complemented the government’s response to COVID-19 in those 40 districts. The Global Fund through its New Funding Model III (NFM3) grant for the Community Systems Strengthening(CSS) for the HIV and TB supported CHAG to work with 99 Civil Society Organizations (CSOs) and Non-Governmental Organizations (NGOs) to improve quality and access to care for persons living with HIV and TB in over 236 districts. In line with CHAG’s core mandate of providing options for the poor and the marginalized, CHAG with funding support from the Department for Health and Social Care (DHSC) provided support to the country’s five refugee camps with interventions on COVID-19, capacity development for improved health care and scholarships to qualified refugees and individuals in host refugee communities for nursing, midwifery and other paramedical training programmes.

Key health service indicators showed an improved performance in 2021 compared to 2020. There was a total of 6,402,610 outpatient visits, compared to 5,716,794 in 2020. This represents an increase of 12% on the 2020 figures and a 5.6% average increase over a 5-year period (2016-2021). Total hospital admissions for the period under review also increased by 11.9% from 534,010 in 2020 to 597,623 in 2021. Over a 5-year period, there has been an average increase of 28.7% in admissions. Among the people who were attended to in 2021, males formed 33.0% whereas females formed 67.0%. Health seeking behaviour which is generally perceived to be higher in females than males, may explain this figure. The highest proportion clients seen (27.1%) were within the 20 to 34-year old age group followed by 35 to 49 years (17.2%). The relatively high performance in 2021 could be attributed to the numerous interventions implemented by CHAG and its member institutions. Intervention such as the CRIB project, helped allay the fears, anxiety and panic that prevented majority of our clients from utilizing health care services in the previous year. The WASH IPC intervention implemented in 25 facilities helped improve the quality of services in the respective facilities. Staff training, the SafeCare quality improvement and skilled personnel at birth were other important contributory factors to the good performance for the year. Total deliveries in 2021 were 139,531, a slight increase of 2.3% over that of 2020, and 2.1% over that of 2016. The number of Caesarian Sections (CS) were 28,718, which represents a decrease of 3.6% compared to that of 2020 but a 12.1% increase over a 5-year period. The proportion of CS cases to total delivery in 2021 was 20.3%, compared to 22.0% in 2020. These are both beyond the WHO recommended rate of 10-15%. The number of children vaccinated for BCG increased from 120,734 in 2020 to 131,960 in 2021 representing an increase of 9.3%, while the bed-occupancy rate, improved from 49.6 to 53.0%. The overall student intake at CHAG Health Training Colleges in 2021 was 5,794 for the twenty-two training schools. This represents 5.3% increase on the 2020 student’s intake. Students pass rate was not released as at the time this report was published

Challenges Encountered in 2021
  1. Recruitment of working agents: As a new Principal Recipient (PR) of the Global Fund, CHAG successfully advertised and selected Hope for Future Generation (HFFG) as a Sub-Recipient (SR) to HIV intervention implementation. The TB Voice Network and STOP TB Partnership were selected as Implementing Partners (IPs) to conduct contact tracing of index TB clients and community case finding respectively.
  2. Collaborations: Major collaborations with the Ministry of Health/ Ghana Health Service were enhanced especially with the National AIDS/STI Control Program (NACP), National Tuberculosis Control program (NTP), Ghana AIDS Commission (GAC), the country offices of UNAIDS and WHO. Additionally, CHAG continued a collaboration with Africaid/Zvandiri from Zimbabwe that supports adolescent and young people’s HIV interventions.
  3. Working aids and guides: Under the period, CHAG developed Standard Operating Procedures (SOPs) to guide the engagement of HIV community cadres. This was done in consultation and partnership with the National Programs (NTP and NACP). All the community cadres were trained in the use of the SOPs. The development of a training manual for Community Peer Paralegals is anticipated in 2022.
  4. Acquisition of a software to manage data: The story of the CSS intervention can best be told with data through program performance. CHAG engaged Africa Current Medical Research Journal to incorporate the HIV/TB program data processes through the Research Electronic Data Capture (REDCAP) for community cadre data collection. Additionally, Vantage was procured to provide analytic and visualization of programme oversight, performance monitoring and tracking. These were deployed to enhance achievement of the targets on the CSS intervention.
Major Milestones
  1. Recruitment of working agents: As a new Principal Recipient (PR) of the Global Fund, CHAG successfully advertised and selected Hope for Future Generation (HFFG) as a Sub-Recipient (SR) to HIV intervention implementation. The TB Voice Network and STOP TB Partnership were selected as Implementing Partners (IPs) to conduct contact tracing of index TB clients and community case finding respectively.
  2. Collaborations: Major collaborations with the Ministry of Health/ Ghana Health Service were enhanced especially with the National AIDS/STI Control Program (NACP), National Tuberculosis Control program (NTP), Ghana AIDS Commission (GAC), the country offices of UNAIDS and WHO. Additionally, CHAG continued a collaboration with Africaid/Zvandiri from Zimbabwe that supports adolescent and young people’s HIV interventions.
  3. Working aids and guides: Under the period, CHAG developed Standard Operating Procedures (SOPs) to guide the engagement of HIV community cadres. This was done in consultation and partnership with the National Programs (NTP and NACP). All the community cadres were trained in the use of the SOPs. The development of a training manual for Community Peer Paralegals is anticipated in 2022.
  4. Acquisition of a software to manage data: The story of the CSS intervention can best be told with data through program performance. CHAG engaged Africa Current Medical Research Journal to incorporate the HIV/TB program data processes through the Research Electronic Data Capture (REDCAP) for community cadre data collection. Additionally, Vantage was procured to provide analytic and visualization of programme oversight, performance monitoring and tracking. These were deployed to enhance achievement of the targets on the CSS intervention. 
  5. Review and adoption of a Community Led Monitoring Intervention (CLM): The CSS intervention saw the incorporation and roll out of the CLM model in 2021 for which monitors were recruited and trained to collect and analyze service utilization data.
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